Rise

Track A: Health Plan Operations (RA & Quality)

Panel: Unpacking the V28 Model

• Benchmark best practices in navigating the new CMS risk adjustment model for MA plans  
• Hear how plans have been navigating the impact on RAF scores and other levers to pull to balance out revenue  
• Gain tips on updating coding practices to maximize value for your plan and your members  

Moderator: 
Lesley Weir 
Senior Director, Solutions Strategy 
Veradigm 

Panelists: 
Dr. Shannon Decker, PhD., MBA, MBA, M.Ed., M.Ed.  
Principal 
VBC One    

Carrie Horn MSHA, BBA, RN, CCDS, CCDS-O, CRC, CPC 
System Director Outpatient Clinical Documentation Integrity 
Baylor Scott & White Health 

Track B: Digital Transformation

A Technology Driven-Approach to Collaborative Care for Medicaid Members with Chronic Conditions

The traditional process of retrospective claims reviews for coding gap closure and comprehensive care isn’t ideal for all lines of business. In most states, retrospective reviews are not allowed for Medicaid members, creating an operational challenge to plans and providers to ensure chronic condition management is not interrupted. By automatically identifying chronic conditions upstream during initial claim submission, health plans & providers can improve risk assessment accuracy and ensure quality care, while reducing the amount of back-and-forth needed to perform accurate and timely reporting. Benefits include: 

• Accuracy from initial submission - Data submitted by Providers is validated and identifies any missing information 

• Operational Efficiency – encourages point-of-care clinical assessment and reduces provider abrasion with fewer volume of retrospective records needed for retrieval 

• Financial Impact – lowers total costs compared to traditional chart retrieval process; Submissions and payment received earlier within revenue cycles compared to retrospective projects 

Jennifer Holman  
Director of Risk Adjustment  
Centene Corporation 

Jessica Columbus, LVN, CCS-P, CRC, CPHQ 
Risk Adjustment Industry Consultant 
Memorial Hermann 

Track C: Plan / Provider Partnerships

Collaborative Compliance: Navigating Regulatory Waters as a Team

• Address the complexities of risk adjustment compliance and how a unified payer/provider approach, with vendor support, can help minimize risks 

• Discover best practices for compliant coding processes across both organizations 
• Review real-world examples where the speakers have dealt with and solved compliance challenges 

Michelle Zilisch 
Director of Product Management  
Episource  

Jenni Monfils, CPC, CRC, CDEO  
AVP, Risk & Quality Provider Engagement Education/CDI 
Molina Healthcare, Inc.

Track A: Health Plan Operations (RA & Quality)

From NLP to Deep Learning AI: Coding Tech Evolution for Risk-Adjustment, Quality, and Compliance

• Assess regulatory changes and health plan objectives to increase completeness, specificity, and accuracy of RA coding while mitigating compliance risk 
• Understand major developments in risk-adjustment coding technology – from yesterday's NLP to today's deep-learning AI – for retrospective, concurrent, and prospective reviews 
• Explore the impact of deep-learning AI for RA coding and quality through real case studies 

Andrew Lockhart 
CEO 
Fathom 

RaeAnn Grossman 
Medicare Advantage Industry Expert 

Track B: Digital Transformation

AI-enabled Analytics for Intelligent, Real-time and Outcomes-focused Healthcare Experiences

• Understand the essential components for establishing a robust analytics architecture: high-quality data inputs, sophisticated  AI models, and actionable, relevant AI outputs 
• Learn how transforming raw data into actionable insights enables downstream analytics, population health management, patient-centered care, and public health initiatives 
• Explore real-world examples of how AI-enabled analytics have significantly improved patient outcomes and organizational efficiency 

Moderator:  
Dr. Shannon Decker,  
Principal  
VBC One 

Panelists:  
Mansoor Khan, SC.D. 
CEO  
Persivia Inc.   

Kristen Phillips 
Associate Vice President 
Lifepoint Health  

Suzzane Fredrick Gruszka 
National Director of Value-Based Optimization 
Sanitas USA 

Track C: Plan / Provider Partnerships

Panel: Focus on Plan / Provider Alignment- Examples in Reducing Provider Abrasion

• Hear examples of how plans are effectively engaging providers to avoid abrasion  
• Learn about data-driven ways that plans are using to meet providers where they are 
• Get tactical ways to get provider buy in, with examples of plans that have had success in this area  

Moderator: 
Mary Feliz, CRC 
Manager, Risk Adjustment Consulting 
Pareto Intelligence  

 
Panelists:  
Kenneth Persaud, MD 
CEO 
White-Wilson Medical Center, P.A.  

Sunita E. Varghees, MD  
VP, Physician Documentation  
Baylor Scott & White Health 

Kwame Appiah-Yeboah 
Director, Risk Adjustment & Revenue Management 
Sentara Health Plans  

Jeremy Cale Browning, MBA, CPC, CRC 
Director – CDE Performance Management 
Ochsner Health Network (OHN) 

Track A: Health Plan Operations (RA & Quality)

Audit Readiness – Keep Calm and Code On

• Get an overview of the audit types – OIG, CMS, RADV, etc. and gain a better understanding of the nuances of each  
• Explore the differences in preparation for small, medium, and larger organizations to identify alternative approaches  
• Examine the changes to RADV extrapolation to confirm understanding and educate your team  
• Distinguish critical stakeholders needed when preparing for an audit  

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP  
Director Risk Capture, Population Health Management   
Mass General Brigham

Track B: Digital Transformation

Panel: The Move to Digital Quality Measurement  

• Unpack new developments in ECDS measures and discuss the future of HEDIS® quality measurement    
• Get best practices in operationalizing the integration of ECDS measure data into existing processes    
• Benchmark best practices for fully digital reporting  

Katharine Iskrant  
President 
Healthy People, Inc.  

Julianne Eckert 
Senior Director, Clinical Quality Programs 
Clover Health  

Track C: Plan / Provider Partnerships

Case Study – Learnings from a Nurse-Led AWV Program that Nearly Doubled Its Rates

• Hear about one group’s innovative program increase AWV Completion rates and decrease provider burden  
• Learn about how cross-functional collaboration contributed to success 
• Walk away with tips on how your organization can increase AWV rates  

Nicole Wright MSN, RN, CBN 
Director of Clinical Coordination  
Inspira 

Renee Cline RN, MSN, CNML 
Manager of Practice Coordination  
Inspira 

Track A: Health Plan Operations (RA & Quality)

Operationalizing the 2025 Changes to Medicare Part D

• Understand what plans need to know about the 2025 Medicare Part D redesign including the financial, operational and strategic implications      
• Discuss ways that plans can adjust their operations to account for the Part D changes  
• Understand the interactions among the changes and how they could offset each other 

Omar Daoud  
Senior Director of Pharmacy 
Community Health Plan of Washington 

Melissa Smith 
Founder 
Newton Smith Group 

Track B: Keys to Compliance

Flip the Script: Using Data and Measures to Identify Potential Fraud

• Get tips on pivoting the use of existing data measures to address potential fraud, waste, and abuse within your book of business and provide practical examples of how data usage has increased the rapid identification of fraud, waste, and abuse indicators 
• Apply standard measures in innovative ways to address fraud, waste and abuse identification    
• Hear lessons learned in implementation and gaining leadership buy-in 

Jennifer Dietz 
Director, Health Care Fraud Division 
Defense Health Agency (OIG) 

Track C: Provider Spotlights

Panel: Spotlight on Providers Addressing Social Drivers of Health

• Discuss the challenges that providers face in addressing SDoH and how to overcome them, including coordinating care with social service organizations  
• Examine reimbursement for meeting SDoH needs 
• Look at ways to improve payer / provider partnerships in meeting the needs of underserved communities

Moderator: 
Laura Sheriff, RN, MSN, CPC, CRC 
Contracting Risk Adjustment Specialist 

Panelists:  
Mital Brahmbhatt, MHA, LMSW 
Director, Health Management 
Memorial Hermann 

Jenni Monfils  
AVP, Risk and Quality Provider Engagement Education  
Molina Healthcare, Inc.

Track A: Health Plan Operations (RA & Quality)

Setting Your Ethical Stars and Risk Adjustment Trajectory 

• Identify the clinical and fiscal ROI for Ethical Stars and Risk Adjustment strategies 
• Define the pillars of an Ethical Stars and Risk Adjustment Strategy  
• Define the quality impact of adopting and ethical strategic plan for Health Equity Index, HEDIS, HOS and CAHPS success 

Melissa Smith 
Founder 
Newton Smith Group 

Tina Dueringer 
CEO, Principal Advisor 
Dueringer Advisors, Inc 

Track B: Keys to Compliance

Panel: The Current State of RA Litigation and Risk Areas for MA Plans, Physician Groups, Vendors and Downstream Entities

• Hear about new developments in various FCA litigations, OIG audits, and other regulatory activities, with focus on what sorts of activities and fact patterns that the DOJ, as well as courts at the pleading stage, are finding to be plausible violations of the False Claims Act as opposed to fact patterns that are not meeting muster 
• Understand the risks and compliance implications of specific retrospective chart review methods, such as chart “refreshing” and “coding parties,” enabling providers and MAOs to make informed decisions and avoid potential pitfalls 
• Equip yourself with knowledge on the challenges and risks of documenting quality metrics under the Stars program in the post-pandemic era, ensuring your organization remains compliant and efficient in a changing environment 
• Stay informed of some predictions of where the future of fraud litigations related to the MA industry seem to be heading as it relates to Risk Adjustment and Star Ratings  

Moderator: 
Mary Inman 
Partner 
Whistleblower Partners LLP  

Panelists:
Jason N. Silberberg, Esq. 
Partner  
Frier Levitt  

Liz Soltan 
Associate  
Whistleblower Partners 

Additional Speakers to be announced

Track C: Provider Spotlights

Bridging the Divide – Keys for Meeting Reporting Goals and Improving Outcomes

• Discuss the disconnect between reporting quality measures and achieving better health outcomes 
• Integrate population health improvement strategies in alignment with the work of providers to reduce abrasion 
• Discuss ways to achieve better scores while creating meaningful change  

Rebecca Yanniello   
Vice President, Population Health  
Regal Medical Group   

Track A: Health Plan Operations (RA & Quality)

Panel: Building Your Bench – Tips on Hiring, Staffing and Retention

• Discuss the current landscape in hiring for Risk Adjustment and Quality roles  
• Benchmark best practices for hiring, the right mix and makeup of staffing and retaining top performers  
• Have an open dialogue of what’s working for plans and risk-bearing provider groups and what’s not  

Moderator: 
Doug Wackowski  
Vice President, Prospective Service Solutions 
Advantmed 

Panelists:  
Colleen Gianatasio CPC, CPCO, CPC-P, CDEO, CPMA, CPPM, CRC 
Director, Clinical Documentation Integrity and Coding Compliance 
Capital District Physician’s Health Plan 

Mark Dabney, PMP    
Director, Risk Adjustment 
Community Health Plan of Washington 

Jeanine Bumford CPC CRC 
Director of Risk Adjustment Operations 
Christus Health  

Track B: Keys to Compliance

Case Study: Master the HHS RADV Audit - Strategies for Success

• Get a better handle on what HHS RADV audits are - break down the audit's purpose, Health Plan requirements, and how results affect risk scores and payments 
• Gain case study insights on HHS RADV audits from a seasoned Risk Adjustment Coding Manager with a proven track record of decreasing error rates year-over-year 
• Be audit-ready with tactical knowledge to ensure a smooth, organized, and compliant audit process including learnings from vendor selection, chart retrievals, the appeals process and more

Amy Jack 
Risk Adjustment Coding Manager  
SelectHealth